This story has been excerpted from an article published by Jason Silverstein in VICE on April 7, 2020. Read the full article here.
Converting a dorm to a quarantine space is straightforward enough
Converting dorm rooms into quarantine spaces is not very difficult, as experts with experience building emergency treatment units for cholera and Ebola in Haiti and West Africa told VICE.
For this to work, dorms need areas for screening, triage, observation, treatment. The first step is to make sure dorms can screen people for the virus as best they can, a step that is frustratingly difficult in the absence of widespread and rapid testing. hush
“If we did point of care, rapid testing, it would be a game changer. We should be able to do that. China did it, South Korea did it, why we are not doing it is beyond me,” said Sheila Davis, the chief executive officer of Partners in Health who led the medical charity’s Ebola response in West Africa.
Without the testing, dorms need to be prepared to screen patients based on symptoms like fever, cough, and shortness of breath, according to David Walton, a physician and cofounder of Build Health International, who helped build the Hôpital Universitaire de Mirebalais after the 2010 earthquake in Haiti, the largest public hospital in the country, “That was very much the case during the Ebola epidemic and cholera epidemic,” Walton said.
Without fast and dependable screening, patients who don’t have COVID-19 might get it because their symptoms are wrongly confused with coronavirus and they are grouped with people with the disease, something that tragically happened during the Ebola outbreak with malaria.
“You want to triage people into confirmed [coronavirus] groups, and also have an area for people who are suspected to have coronavirus,” Marsh said. “In that space you would want to be very strict about keeping patients from coming into contact with each other. Some of these people will just have the flu or cold, and we don’t want to give them COVID.”
Dorm rooms themselves need to have negative pressure, so that the air flows outside and not around the room. “That would not be that hard,” Marsh said.
Imagine a standard dorm room that is 10 feet by 10 feet with a door and a window. “What you do is put a vent in the bottom of the door and then you put a mechanical whirly bird [turbine] to the outside world and that bird sucks air outside of the room and that creates negative air flow,” Marsh said.
To protect patients and health care providers, the entire volume of air in every dorm room must be refreshed 12 times per hour, per CDC guidelines. Doing so would be a simple math and construction problem: solve for the cubic feet of air in the room and set up an exhaust fan that can move that much air 12 times an hour.
Within the rooms themselves, there needs to be some monitoring equipment that allows nurses and health professionals to keep an eye on patients. This is why dorms cannot be used for intensive care units, because workers can’t see the equipment as they’re doing rounds—they have to walk inside each room. “In terms of an ICU setting, dorms are the worst possible setting, because they are individual rooms that are purposefully built for privacy,” Davis said.
Replacing the doors with glass so that nurses have a line of sight to patients is one option; another creative solution is to monitor oxygen in the blood and pulse rates via iPhones as opposed to traditional pulse oximeter machines in each room. “Private rooms are great and critical for COVID,” Walton said. “But you can’t have them in a single room with the door closed if you don’t have a pulse oximeter on them.”
Some patients will need to get from dorm to hospital
What makes dorms especially useful for quarantine is that they are often near hospitals, which would allow for a speedy transfer in the event that a patient gets rapidly worse, something that is common with the sickest coronavirus patients. “There is this weird feature of coronavirus. Some people fall off the cliff late and suddenly,” said Marsh. “As an emergency doc that petrifies me. If you get suddenly sick, how will you get to the hospital?”
Whereas in other disasters, Walton explained, we might need to construct separate treatment centers near a main hospital, many dorms already are located near medical centers and hospitals. This is true in the Philadelphia, Los Angeles, and New York City areas, according to a VICE review of dorms and hospitals.
While dorms offer some built-in structural advantages, such as running water and stable electricity and areas that can be used for staff, one major structural challenge is whether rooms have private bathrooms. It might make sense to save those rooms for patients without confirmed COVID-19 so they do not catch coronavirus from someone who does.
“That’s the needle to thread,” said Walton. “How do we not make the perfect the enemy of the good, and at the same time do things as safely as possible? Dorms are an imperfect solution, but if it is going to help save lives I’m absolutely all for it.”